Evaluation and Management of Adolescents with Abnormal Uterine Bleeding

Abstract

The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB.

A New Risk Index Combiningd-Dimer, Fibrinogen, HE4, and CA199 Differentiates Suspecting Endometrial Cancer From Patients With Abnormal Vaginal Bleeding or Discharge

“…However, this primary symptom is not specific for EC. [30][31][32] Pathological examination, the diagnostical gold standard for EC, is not a routine inspection due to the shortage of pathologists, especially in areas underdeveloped at the medical level. Thus, the timely screening of suspected patients with EC from patients with abnormal vaginal bleeding or discharge to achieve a definite diagnosis and select a treatment strategy as early as possible are very important.…”

Keap1-targeting microRNA-941 protects endometrial cells from oxygen and glucose deprivation-re-oxygenation via activation of Nrf2 signaling

“…Postpartum hemorrhage is one of the most common complications in obstetric practice [1][2][3], resulting in ischemia to the endometrium and necrosis of endometrial cells [1][2][3]. To study the pathophysiology of ischemic death [4,5], the oxygen and glucose deprivation (OGD)re-oxygenation (OGDR) model is a useful approach to investigate ischemic-reperfusion endometrial cell injury [6][7][8][9].…”

“…To study the pathophysiology of ischemic death [4,5], the oxygen and glucose deprivation (OGD)re-oxygenation (OGDR) model is a useful approach to investigate ischemic-reperfusion endometrial cell injury [6][7][8][9]. Following reperfusion, endometrial ischemia induces oxidative stress to the endometrial cells [1][2][3], leading to the accumulation of reactive oxygen species (ROS) and depletion of antioxidants [10][11][12]. Oxidative injury causes excessive DNA breaks, protein damage and mitochondrial dysfunction [10][11][12], eventually leading to endometrial cell necrosis [1][2][3].…”

“…Following reperfusion, endometrial ischemia induces oxidative stress to the endometrial cells [1][2][3], leading to the accumulation of reactive oxygen species (ROS) and depletion of antioxidants [10][11][12]. Oxidative injury causes excessive DNA breaks, protein damage and mitochondrial dysfunction [10][11][12], eventually leading to endometrial cell necrosis [1][2][3].…”

Keap1-targeting microRNA-941 protects endometrial cells from oxygen and glucose deprivation-re-oxygenation via activation of Nrf2 signaling

“…Postpartum hemorrhage is one of the most common complications in obstetric practice [1][2][3], resulting in ischemia to the endometrium and necrosis of endometrial cells [1][2][3]. To study the pathophysiology of ischemic death [4,5], the oxygen and glucose deprivation (OGD)-re-oxygenation 3 (OGDR) model is a useful approach to investigate ischemic-reperfusion endometrial cell injury [6][7][8][9].…”